Provider Demographics
NPI:1184838252
Name:HOLCOMB, JENNIFER L (ATC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 DAY DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-5961
Mailing Address - Country:US
Mailing Address - Phone:208-344-7536
Mailing Address - Fax:
Practice Address - Street 1:8000 S FEDERAL WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-9632
Practice Address - Country:US
Practice Address - Phone:208-363-3246
Practice Address - Fax:208-368-4646
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-2032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer